Task poster
VAMSI
Essayexample2.pdf
Leadership and
collaborative working in
Public Health and
Healthcare
Analysis of Leadership and Management applied to Healthcare By: [Name]
Analysis of Leadership and Management applied to Healthcare
1
Introduction
Healthcare organisations are developed in a complex system that is hard to predict
due to their changing nature (Weberg, 2012). Understanding the complexity of the context
has been important to raising awareness on how Healthcare organisations must be
understood in order to improve their performance (Ghiasipour et al., 2017; Belrhiti, Nebot
Giralt, and Marchal, 2018). For instance, these arguments have been used in the literature
to justify that the success of the performance of Healthcare settings is subject to different
interconnected and complex components, like an adequate level of skills, knowledge,
competencies, and a high level of motivation among the workforce (Mosadeghrad, 2014).
Interestingly, the components mentioned before have a common element, the members
of the staff, who show all those characteristics through their performance. According to
this, Plsek and Wilson (2001) understood that the focus on delivering good practice
should be shifted to developing appropriate knowledge about the individuals who are in
charge of leading those members of the staff, and as a consequence exploring how
leadership and management play an important role in the interactions that are produced
within the complexity of Healthcare organisations. In the United Kingdom, the relevance
of strong leadership and management has also been stated as a core element for the
success of the Healthcare system, the NHS England (2014) has settled a 5 years forward
view scenario where leadership and management, in conjunction with the promotion of a
positive culture, are key elements for achieving a high-quality care, and it is not surprising
that they are investing in training people with strong leadership skills to ensure that they
will deliver a good service (NHS England, 2018). Therefore, this essay has the aim to
critically discuss what are leadership and management and how the different models can
play a fundamental role in the success of Healthcare organisations.
Discussing leadership and management, are they the same thing?
Leadership and management started to be conceptualised as two different things more
than 40 years ago, thanks to the work of Abraham Zaleznik (1977), who considered that
these two concepts had different roles in the organisation. In the following years, a very
broad range of authors developed an extensive literature of knowledge regarding these
two concepts (Bennis and Nanus, 1985; Gardner, 1990; Kotter, 1990), and interestingly
today it is still easy to find a debate on how the differences among management and
leadership can be used to achieve the success of the organisation (Toor and Ofori, 2008;
Bass, 2010; Algahtani, 2014) . In this aspect, Kotter´s (1991) conclusions about
Analysis of Leadership and Management applied to Healthcare
2
leadership and management are very remarkable for analysing how these two elements
can be linked to deliver high-quality standards in a complex Healthcare system, saying
that ´Managing is about coping with complexity, leadership is about coping with change´
(Kotter, 1991, p.32). Then, it is possible to affirm that, even though they are two different
things, both, managers and leaders are needed for any effective organisation (Kotter,
1991). An interesting interpretation to Kotter´s (1991) statement can also lead to thinking
that managers are people in charge of confronting the chaos of the organisations with the
aim of bringing consistency to them (Kotterman, 2006). However, if manager is about
efficiency and leadership is about bringing change, and successful change is about
motivating people to work towards the same vision in an active way while creating a
positive culture (Hechanova, Caringal-Go and Magsaysay, 2018), then using Gill (2011)
definition of leadership can be useful to understand how effective leadership can be linked
to success.
Leadership is showing the way and helping others to pursue it. This entails
envisioning a desirable future, promoting a clear purpose or mission, supportive
values and intelligent strategies, and empowering and engaging all those concerned.
(Gill, 2011,p.9).
When analysing and comparing these two concepts it seems that there is a general trend
to assume that managers apply solutions to problems following the procedures of the
organisations, while leadership plays a fundamental role in bringing innovative solutions
when the situation is unpredictable (Weberg, 2012). Therefore, leadership is associated
with words like visionary or with strong statements like doing the right thing, while
managers are more focused on the task and doing the things right (Azad et al., 2017),
Kotterman (2006) uses the terminology unimaginative cold to illustrate the general
perception of managers work in the organisations. However, a perfect example of how
this conceptualisation might affect the effectiveness of a Healthcare organisation can be
found in the United Kingdom with the case of Mid Staffordshire Hospital, where the basic
principles of care were ignored, resulting in catastrophic results for both, the organisation
and the patients, due to the lack of effective leadership and management (Francis, 2013),
this means that both roles share a responsibility on the results of the organisation (Azad
et al., 2017). Then, affirming that management and leadership focus on different things
might be right depending on the context, but it is also important to understand that in
Healthcare, managers and leaders have the same moral duties and obligations towards the
Analysis of Leadership and Management applied to Healthcare
3
costumers to deliver a high quality of care (Parand et al., 2014). For this reason, the
differences between those two components might not be as clear as Zaleznik (1977) or
Kotter (1990) identified in their work. In conclusion, not just leadership and management
is needed for the success of the organisations, it is also important to understand that both
can share similar skills and they are not two completely different elements, in
contraposition, it is essential that they are both integrated, in any successful Healthcare
organisation (Parand et al., 2014).
Theories of management and leadership, skills and application to practice
There is a very broad literature in leadership and management theories, however, since
Healthcare is a complex system which is constantly changing, it seems that traditional
models about leadership are not appropriate for describing which behaviors are the best
ones for the success of Healthcare organisations (Weberg, 2012). When analysing the
traditional leadership theories it is possible to understand that leadership is mainly based
on the individual capacities of influencing the staff trough elements like motivation, the
use of rewards and punishment or even manipulation (Bass, 2010), however the main
problem of this statement, when it is applied to Healthcare, is how it draws an individual
who holds a role, rather than an individual who has a set of behaviours to influence people
(Plowman & Duchon, 2008). Therefore, it is fundamental to use a model of leadership
and management in Healthcare suitable for facing the challenges of working in an
innovative system (Weberg, 2012).
In management, the system approach has been broadly applied in Healthcare systems
(Waterson, 2009), this is not surprising considering that patient safety has been one of the
focus of improvement in the last few years (Edworthy et al., 2006; Benning et al., 2011;
Weaver et al., 2013). The most extensive model in patient Safety was developed by
Reason´s (2000) and is called the Swiss Cheese Model of safety. From the broad spectrum
of models that can be applied to management in Healthcare, the Swiss Cheese Model
stands out from others because Reason (2000) understood that due to the complexity of
care, human errors were going to be made, and those errors won´t be avoided by using
punishment, instead there was a need to prevent the mistakes and therefore avoid the
potential harm that they could produce. Collins (2014) uses the example of avoiding
wrong-site surgeries during operations for understanding how this model can suit the
demands of the Healthcare system. Every slice of the Swiss cheese represents a way to
prevent errors, in the case of avoiding wrong-site surgery three are the slices that can be
Analysis of Leadership and Management applied to Healthcare
4
used, key stakeholder support, surgical safety checklist, and the communication among
the team and their collaborative work (Collins et al., 2014). Each slice has holes, and
when they line up, they represent possible errors, which can be latent errors or active
errors (Reason, 2000). From this particular situation, the latent errors are product of the
organisation structure or design, then this could go from failure in administering antibiotic
medication because of the lack of reviewing allergies before administering, to aspects of
the Healthcare organisation that interfere with the members of the staff producing them
distress or a lack of concentration (Collins et al., 2014). On the other hand, active errors
are easy to spot because they are produced by the staff mistakes usually at the time of
performing tasks in the system, for example, following the previous example an active
errors would be giving the wrong medication, or conducting a surgery in the wrong limb
(Collins, et al., 2014). The application of this model in Healthcare not just avoids giving
the responsibility of outcomes to just one individual, it gives a broader view that helps
analysing the situation from a nonlinear perspective, where relationships among the
components are important, and therefore it allows a space of analysis where errors can be
fixed (Collins, et al. 2014).
Another relevant approach of management is the contingency approach, which states that
there is not a right path for managing, due to the diversity and complexity of the
organisations, not all methods can work the same way for the different organisations
(Engelseth and Kritchanchai, 2018). One of the characteristic aspects of this theory is the
differentiation between internal factors, which includes the climate and the culture of the
organisation, and external factors like healthcare policies when analysing which strategy
should be adopted (Mintzberg,1979). Contrary to The Swiss Model, the application of
this approach to the decision-making process hasn´t been clearly defined (Lamminen et
al; 2015). However, it makes sense to affirm that having awareness of both, internal, and
external factors, is fundamental in order to follow a strategy that suits the demands of
competitive and complex Healthcare system, and therefore it has a direct implication in
the decision-making process (Lamminen et al; 2015). In the particular setting of
Healthcare, this approach can be useful when applied to situations where change is needed
because there is a need to follow a strategy where changing the culture and paying
attention to structural processes of the organisations is fundamental for success (Mackian
and Simons, 2013). A personal example where this approach can be useful is in the setting
of a care home for people with learning disabilities, where the staff wasn´t engaging
Analysis of Leadership and Management applied to Healthcare
5
appropriately with basic tasks, like signing for medication or following the support plans.
In this kind of situation, there is a need for a deep restructuration of the workplace, then
for conducting successful change, it requires a manager that can control the different
variables around them (Engelseth and Kritchanchai, 2018).
As it has been mentioned before, there is also a broad set of leadership theories, in this
essay it is argued that two are the most suitable for facing the demands of the complex
system. The first one is transformational leadership, which has been linked with a positive
culture in Healthcare organisation and patient’s safety (Page, 2004). The strongest aspects
of this theory rely on the skills that a transformational leader has, like charisma, effective
communication, creativity or innovation, which are linked to the capacity of creating
followers who are motivated to work towards a vision (Burke and Friedman, 2011; Al-
Sawai, 2013). In the context of the NHS applying transformational leadership could be
useful for the improvement of the Children and Young People Mental Health Services
(CAMHS), which are facing a process of change due to a need for improving the services
delivered, in fact in Future in Mind (2015) it is specified the need of leaders to supervise
that change is efficiently integrated across the Mental Health Services. Transformational
leadership has been proved to be linked to positive attitudes among teams and improving
the quality of service and care (Saravo, Netzel and Kiesewetter, 2017; Sfantou et al.,
2017). Therefore, it is argued that transformational leadership is suitable for modern
healthcare environments because they facilitate change, trough the transmission of the
vision to the staff while motivating them to pursue the goals (Kumar and Khiljee, 2016).
Even though transformational leadership has been mentioned in the literature as the ideal
model of leadership (Mackian and Simons, 2013) it can be criticised by saying that it
glorifies the figure of the leader as an individual (Bolden, 2011). For this reason, it is
argued that distributed leadership is a good alternative to this approach (Bolden, 2011).
Considering this approach over others might result surprisingly at the beginning,
nonetheless, when paying attention to the massive number of variables inside the settings
of Healthcare, it results interesting to adopt an approach where leadership relies on many
members rather than one (Mackian and Simons, 2013). In the past, Healthcare systems
like the NHS have prompted the application of leadership to small groups of senior staff
(Miller and Sitton-Kent, 2016), however, improvements might be needed at any level of
the organisation, for this reason in order to improve the quality of care it makes sense to
use a theory where leadership can be used in specific settings without needing a senior
Analysis of Leadership and Management applied to Healthcare
6
member of the staff (Boak et al., 2015). A perfect example on how the lack of distributive
leadership can affect the quality of the service delivered by the Healthcare system can be
seen in the example of Mid -Staffordshire mentioned before, Francis (2013) stated that
part of the lack of a professional service was due the poor management and leadership,
and due to this they ignored the needs of different levels of the organisations. Therefore,
it can be concluded that distributed leadership could have been useful for spotting these
issues at an early stage (Beirne, 2017). Moreover, there is increasing investment in
innovating in specialised services such as cancer services that will need the work of staff
with a background from different disciplines at a multi-level, which at the same time will
require the use of multiple leaders to handle those situations (Beirne, 2017).
Effective leadership and management are the key pieces for successful Healthcare
organisations (Sfantou et al., 2017), for this reason it is not surprising that the NHS offers
wide range of programs that aim to help staff to get trained in leadership and management
skills, for example, the Mary Seacole Programme or the Edward Jenner Programme (NHS
England, 2018). When looking at the content of this programmes it is possible to observe
that they include skills that have been traditionally attributed to management, like
technical skills to organise the tasks, do the planning and budgeting and organise,
conceptual skills that help managers to understand what they need to do and to make
decisions, and interpersonal skills useful for motivating and manage people (Burke and
Friedman, 2011). One skill that is not frequently mentioned in the programs but results
very useful in Healthcare is proactiveness, because the hierarchical distribution of
management can limit those managers who are in the lower and high positions of the
organization (Mackian and Simons, 2013), for this reason, successful Healthcare
organizations need proactive managers with self-awareness who understand themselves,
their values and their motivations, and managers able to use this knowledge to influence
their performance at work in difficult situations (Mackian and Simons, 2013). On the
other hand, when it comes to leadership, the Leadership programs seems to agree that the
skills that need to be taught are identified in nine different dimensions (NHS Leadership
Academy, 2013). Those dimensions are prioritising care and being able to be aware of
the needs of others, understand the vision and communicate it to the staff, being able to
create good relationships with the team, create followers through the influence power,
being creative and critical when evaluating and considering the information, being
influential with the results, being trustable, aware of the context and finally being
Analysis of Leadership and Management applied to Healthcare
7
innovative (NHS Leadership Academy, 2013). These dimensions are particularly
important in Healthcare because they have been designed to avoid situations where
mistakes were made in the past, like Mid Staffordshire (NHS England, 2018). Based on
this, it can be concluded that a fundamental skill for success in Healthcare is empathy,
just as Francis (2013) highlighted in his report, having empathy for others and listening
to people’s feelings is fundamental for guaranteeing patient´s safety and therefore the
success of the organisation.
In conclusion, just by the cooperation of the staff, and the use of their skills in the
performance, Healthcare organisation will be able to survive to the big challenges that
will have to face due to the complex nature of the system (NHS England 2014)
Analysis of Leadership and Management applied to Healthcare
8
References:
Algahtani, D. (2014). Are Leadership and Management Different? A Review. Journal
of Management Policies and Practices, 2(3).
Al-Sawai, A. (2013). Leadership of Healthcare Professionals: Where Do We
Stand?. Oman Medical Journal, 28(4), pp.285-287.
Azad, N., Anderson, G., Brooks, A., Garza, O., O´Neil, C., Stutz, M. and Sobotka, J.
(2017). Leadership and Management are One and the Same. American Journal of
Pharmaceutical Education, 816(6), pp.1-5.
Bass, B. (2010). The Bass Handbook of Leadership. New York: Free Press.
Beirne, M. (2017). The reforming appeal of distributed leadership. British Journal of
Healthcare Management, 23(6), pp.262-270.
Benning, A., Ghaleb, M., Suokas, A., Dixon-Woods, M., Dawson, J., Barber, N.,
Franklin, B., Girling, A., Hemming, K., Carmalt, M., Rudge, G., Naicker, T., Nwulu,
U., Choudhury, S. and Lilford, R. (2011). Large scale organisational intervention to
improve patient safety in four UK hospitals: mixed method evaluation. BMJ,
342(d195), pp.1-14.
Boak, G., Dickens, V., Newson, A. and Brown, L. (2015). Distributed leadership,
team working and service improvement in healthcare. Leadership in Health Services,
28(4), pp.332-344.
Bolden, R. (2011). Distributed Leadership in Organizations: A Review of Theory and
Research. International Journal of Management Reviews, 13(3), pp.251-269.
Bennis, W. and Nanus, B. (1985). Leaders: The strategies for taking charge. New
York: Harper and Row.
Belrhiti, Z., Nebot Giralt, A. and Marchal, B. (2018). Complex Leadership in
Healthcare: A Scoping Review. International Journal of Health Policy and
Management, 7(12), pp.1073-1084.
Burke, R. and Friedman, L. (2011). Essentials of management and leadership in
public health. Sudbury, Mass.: Jones & Bartlett learning.
Collins, S., Newhouse, R., Porter, J. and Talsma, A. (2014). Effectiveness of the
Surgical Safety Checklist in Correcting Errors: A Literature Review Applying
Reason's Swiss Cheese Model. AORN Journal, 100(1), pp.65-79.e5.
Department of Health (2015) Future in Mind: Promoting, Protecting and Improving
our Children and Young People’s Mental Health and Wellbeing. Department of
Health.
Edworthy, J., Hignett, S., Hellier, E. and Stubbs, D. (2006). Patient safety.
Ergonomics, 49(5-6), pp.439-443.
Engelseth, P. and Kritchanchai, D. (2018). Innovation in healthcare services –
creating a Combined Contingency Theory and Ecosystems Approach. IOP
Conference Series: Materials Science and Engineering, 337, p.012022.
Analysis of Leadership and Management applied to Healthcare
9
Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust public
inquiry. London: The Stationery Office.
Gardner, J. (1990). On leadership. New York, NY: The Free Press.
Ghiasipour, M., Mosadeghrad, A., Arab, M. and Jaafaripooyan, E. (2017). Leadership
challenges in health care organizations: The case of Iranian hospitals. Medical
Journal of the Islamic Republic of Iran, 31(1), pp.560-567.
Gill, R. (2013). Theory and practice of leadership. Thousand Oaks, CA: Sage
Publications.
Hechanova, M., Caringal-Go, J. and Magsaysay, J. (2018). Implicit change
leadership, change management, and affective commitment to change. Leadership &
Organization Development Journal, 39(7), pp.914-925.
Kotter, J. (1990). What leaders really do. Boston: Harvard Business School Pub.
Corp.
Kotterman, J. (2006). Leadership versus management: what's the difference?. The
Journal for Quality and Participation, 29(2), pp.13-17.
Kumar, R. and Khiljee, N. (2016). Leadership in healthcare. Anaesthesia & Intensive
Care Medicine, 17(1), pp.63-65.
Lamminen, J., Forsvik, H., Voipio, V., & Lehtonen, L. (2015). Decision making
process for clinical it investments in a public health care organization–contingency
approach to support the investment decision process. Finnish Journal of eHealth and
eWelfare, 7(2-3), pp.122-134.
MacKian, S. and Simons, J. (2013). Leading, managing, caring. London: Routledge.
Miller, P. and Sitton-Kent, L. (2016). Leadership & Leadership Development in the
NHS: A Short Review. East Midlands Academic Science Network, pp.1-62.
Mintzberg, H. (1979). The structuring of organizations. Englewood Cliffs, N.J.:
Prentice-Hall.
Mosadeghrad, A. (2014). Strategic collaborative quality management and employee
job satisfaction. International Journal of Health Policy and Management, 2(4),
pp.167-174.
NHS England. (2014). NHS England » NHS Five Year Forward View. [online]
England.nhs.uk. Available at: https://www.england.nhs.uk/publication/nhs-five-year-
forward-view/ [Accessed 26 April 2019].
NHS England (2018). Leadership Development. [online] Available at:
https://www.england.nhs.uk/wp-content/uploads/2018/03/leadership-
development.pdf [Accessed 26 April 2019].
NHS Leadership Academy (2013), The Healthcare Leadership Model, version 1.0,
Leeds: NHS Leadership Academy.
Analysis of Leadership and Management applied to Healthcare
10
Page, A. (2004). Transforming Nurses’ Work Environments to Improve Patient
Safety: The Institute of Medicine Recommendations. Policy, Politics, & Nursing
Practice, 5(4), pp.250-258.
Parand, A., Dopson, S., Renz, A. and Vincent, C. (2014). The role of hospital
managers in quality and patient safety: a systematic review. BMJ Open, 4(9),
pp.e005055-e005055.
Plsek, P. and Wilson, T. (2001). Complexity science: Complexity, leadership, and
management in healthcare organisations. BMJ, 323(7315), pp.746-749.
Plowman, D. A., & Duchon, D. (2008). Dispelling the myths about leadership: From
cybernetics to emergence. In M. Uhl-Bien & R. Marion (Eds.), Complexity leadership
part 1: Conceptual foundations. Charlotte, NC: Information Age Publishing. (pp.
129–153)
Reason, J. (2000). Human error: models and management. BMJ, 320(7237), pp.768-
770.
Saravo, B., Netzel, J. and Kiesewetter, J. (2017). The need for strong clinical leaders
– Transformational and transactional leadership as a framework for resident
leadership training. PLOS ONE, 12(8), p.e0183019.
Sfantou, D., Laliotis, A., Patelarou, A., Sifaki- Pistolla, D., Matalliotakis, M. and
Patelarou, E. (2017). Importance of Leadership Style towards Quality of Care
Measures in Healthcare Settings: A Systematic Review. Healthcare, 5(4), p.73.
Toor, S. and Ofori, G. (2008). Leadership versus Management: How They Are
Different, and Why. Leadership and Management in Engineering, 8(2), pp.61-71.
Waterson, P. (2009). A critical review of the systems approach within patient safety
research. Ergonomics, 52(10), pp.1185-1195.,
Weberg, D. (2012). Complexity Leadership: A Healthcare Imperative. Nursing
Forum, 47(4), pp.268-277.
Weaver, S., Lubomksi, L., Wilson, R., Pfoh, E., Martinez, K. and Dy, S. (2013).
Promoting a Culture of Safety as a Patient Safety Strategy. Annals of Internal
Medicine, 158(5_Part_2), p.369.
Zaleznik, A. (1977). Manager and leaders: are they different?. Harvard Business
Review, 55(3), pp.67–78.
